So Mediocre it Hurts

miffed

I don’t appreciate being told to do my job when I’m already doing my job. And in fact, I’m drowning in my job. Furthermore, sometimes things don’t have answer in a box wrapped in a neat tidy bow. Sometimes there are no answers. I understand you are frustrated, probably scared, and at your wits end. 

i also, don’t appreciate being talked to like that, when I’ve never even met you, talked to you, or even seen you. So how exactly are you to tell me to do my job, when you haven’t even been in to be evaluated by me? 

I’m very tired. And so are you. But I don’t see how talking to me like that will help you. I won’t tell you how to speak to me. I will simply do my best to help, but know that I do remember what you say to me and I just further plants a rift between me and me wanting to help people overall. 

i love medicine but there are many days where I just want to stay home and not have to deal with people who think it’s ok to talk their provider like they themselves are their own doctor and demand tests and medications they do not need or pose harm to themselves. If you so adamantly believe you know everything that you need, then why are you coming in to see me? 

I just don’t get it. 

uuuugh people please for the love of God get vaccinated. I don’t want to be redeployed to the hospital. There’s a reason why i didn’t go into that work. Your docs and especially your RN and RTs are tired. 

no one will care for your lily white ass dyin’ of COVID if yall keep going like this because compassion fatigue is a real thing. 

it’s really hard to keep feelin sorry for people who die from something that is essentially preventable after we harp on you and everyone else harps on you about it and you turn your back on us and say we’re sus. 

if we’re so sus, how come you come to us to treat you for your heart attacks, strokes, diabetes, hypertension and everything else under the sun? You trust that aspect of medicine but you won’t trust other aspects? 

cuz if that’s the case, then who’s to say treating your diabetes is a load of hogwash and just a conspiracy to get you to inject yourself with stuff that’s not actually insulin but a mind controlling substance laced with other shit? it’s a real slippery slope you’re on and you’re putting your own health and life on the line over the *possibility* of long term side effects. Meanwhile, the actual disease and it’s Delta variant are *very real* and does not discriminate on who it infects. 

You’re not special. You are mortal and a human being. Last time I checked, human beings are susceptible to chance and probability. Perish the “oh it’ll never happen to me” thought, because it can and it very likely will given how prevalent it is right now all over the country. Chances are, your neighbor may have gotten it, that grocery store clerk may have gotten it, that person you typically see at work may have just died the other day in the ICU from it, and you wouldn’t have known it b/c we’re still pretty much in quarantine. 

i am just so tired of this. and now i’m very likely gonna have to go back to working in a hospital when I still got loads of patients outside the hospital trying to schedule an appointment to see me for something else they’ve put off for a whole fucking year or longer because of COVID and they may be getting worse and more sick, but I can’t see them, because i’m now being pulled to the hospital being overfull with patients. there ain’t enough hospitalists to go around and those hospitalists who are working are probably just as, if not more, sick of your shit. And it’s not made better when say a bunch of your staff quit because they just couldn’t take the workload anymore. 

do you get it? do you get it now, how much your actions are affecting everyone else? or do you just not care? because if you don’t, then don’t be surprised when people don’t treat you with care like they should and normally would because they’re probably at their wits end and you’re patient number ### who refused the vaccine and ended up coming for help gasping for air or dying of multi-organ failure when everyone is incredibly short-staffed and doing the work of 2 other people. 

cranquis:

modernathenamd:

wayfaringmd:

hawthorn-and-ivy:

Just for context for those of you not in medicine, the average time to get in with endocrinology from time referral is completed to appointment is basically 8-12 weeks or longer, unless the endocrinologist thinks you’re dying in the hospital basically. Endocrinology and rheumatology are hands down the hardest specialties to get someone into, and it turns out not feeling good and being in pain are not the triage criteria for dying. 

I had a patient fire me as their PCP today essentially because I cannot force endocrinology to see someone. They’re leaving to “find an office that can process referrals and refills more efficiently” (refills noted because I didn’t fill a script within 4.5 hours of receiving a request) and then had the audacity to ask for immediate refills and referrals right afterwards. 

Low key wish I could watch them discover that minimum it’s going to take 2 weeks to get established with a new PCP (most recent stats suggest this is more like 18 days) and then find out that endocrinology still takes 8-20 weeks to get into, all the while also having to realize that actually all PCP offices have a policy on how long it takes to respond to a refill request, and that it doesn’t actually matter how many times a medication is sent to the pharmacy if the pharmacy has the med on back order. 

smh. Like, I get that patients don’t understand how the utterly convoluted and terrible USA system works, but when I am explaining that I actually have no control over an endocrinologists schedule, asking for me to somehow put an appointment in to a clinic I don’t work at in a system I don’t work in or have access to is basically asking me to use a magic wand.  

For more perspective: in the small town I’m in its more like 3-6 months to see endocrinology. I did manage to get someone in with thyroid storm in 6 weeks which means I manage them in the meantime 👎🏼. I have another patient with multiple endocrine gland failure (thyroid, parathyroid, type 1 DM, gonads) and we did get them in to endo in about 3 months. Rheum is just as bad or worse. They’re 9-12 months out for new patients near me. So I usually do most of the rheum work up and start what meds I can but I can’t start them on fancy biologics. It sucks. Neuro is available fairly quickly but there are maybe 2 good ones near us who who’ll actually put forth an effort to search for a diagnosis on patients with weird symptoms. My patient with autoimmune encephalitis (yep, don’t see that 🦓 everyday) was told it would be 3 months before they could be seen. It took multiple calls and 80+ pages of faxed records proving the diagnosis before they’d see the patient earlier.

Also for folks to realize: most specialists haven’t reviewed your records before they see you. The doctors often have no say in when you are scheduled and don’t see the referral info in advance of the visit. Someone who may not even have clinical experience is usually in charge of scheduling you. So if you have a weird/acute/severe issue that requires quick attention, it often takes a phone call direct from your PCP to the specialist or their assistant to get you seen in a timely manner. Example: cardiology scheduled my patient’s stress test 6 weeks out because the referral was from GI (patient insisted it was reflux when I told them it was angina. GI agreed it was angina). I called and got the test moved up to 3 days out. Patient had coronary artery bypass surgery 2 days after the test. They likely didn’t have 6 weeks to wait. So if you feel like your wait is too long, you can ask your PCP to intervene, but if they tell you it still won’t happen any faster or that there are sicker patients in line ahead of you who can’t be postponed, believe them and back off.

Regarding speed of referrals and scheduling, non-med folks also need to understand that under-staffing is an issue everywhere, and it’s not necessarily one we can fix quickly. My office is down 2 people right now, which means our 3 MAs are all doing the work of 1.5 people now. We are hospital owned so we only get the staff the hospital says we can have, so we may or may not get a fill-in person some days to help. For privately owned offices, it often means big money and time to hire and train new folks. It can’t be fixed quickly. And medical staff get sick just like regular people do. If your doctor has a massive kidney stone and has to have lithotripsy, as my partner did once, then your refills might be a tad late. Give them some grace. You don’t know what’s going on behind the scenes, and I assure you that nobody is sitting around playing games and checking TikTok during work hours in a medical office. If your stuff doesn’t get done, it usually means someone else had more pressing issues than you did.

And finally, it would be great if some patients realized that in medicine, the customer is not always right and customer satisfaction is not always priority #1 (yeah yeah patient satisfaction surveys are a thing but your doctors mainly care about practicing good medicine). Put on your big kid panties and take some personal responsibility. Don’t get mad that it took 4 hours to respond to your call. You are not your doctor’s only patient. They can’t drop everything to send in your viagra because there might be someone having a heart attack in the office and that’s kind of more important to deal with. Remember that failure to plan on your part does not make for an emergency on my part. Keep track of your meds. Ask for refills at your appointment or call a few days before you run out so you have a buffer. Take your meds with you to appointments so they can be checked to avoid errors in prescribing. If you feel like you are waiting too long for an appointment, call first thing in the morning and ask to be worked in if there are cancellations. We are eager to fill empty spots. Take some initiative.

I second all of this. I have had patients yell at me about referrals and sometimes I can help, but mostly I can’t. Derm takes 3 months minimum, there is no such thing as an emergency in their book. Yesterday I got yelled at because a local chiropractor wasn’t answering the patient’s phone calls…. I never referred to that chiro, or any chiro. The patient set this up themselves. Or two days ago when someone sent a rambling message about how unhappy he was with his care through a GI doc at the competing hospital network- not because we’d referred him, but because their office wasn’t answering his repeated same-day messages fast enough.

Originally posted by 1starryeye

I rant about the customer-service direction medicine is being forced in every day. I have a patient who stopped taking all their meds (not due to cost or lack of access or lack of insurance, just because they didn’t want to take them) and then, understandably, their lab work reflected this very visibly. I had to complete paperwork for them, which now reflects this lab work that they caused themselves, and for the last 3 weeks we’ve gotten angry phone calls, portal messages saying we’ve ruined their life, and a 3 hour irate sit-in staged in my waiting room demanding that I change my documentation (ie LIE) which only ended when the police were called. Someone else said I was violating my Hippocratic oath if I didn’t refill a Med they’ve been out of for several months, when they haven’t come into the office for over two years and haven’t had labs for that Med in 4y- and it’s not a life-threatening Med if they don’t get it.

Sometimes I wish more people understood more about medicine. Other days I wish we weren’t moving towards such a customer-service based society. But every day I am just exhausted by people.

Just gonna print out this entire thread in 96-pt font and hang it on the waiting room wall.

WORD. THIS. ALL OF THIS. I AM SO TIRED and I haven’t even been a year out from residency. JFC

marraphy:

catgirl-smash:

catgirl-smash:

senritsu:

senritsu:

roommates of tumblr, stop using metal utensils on your roommates nonstick pans and stop soaking their cast iron pans in soap thank you and god bless

roommates of the world: it doesn’t actually matter if you use metal on nonstick every once in a while

their pans:

for those wondering, those scratches are where the non-stick coating has been scraped off (usually by metal utensils or cleaning utilities like steel wool), which means that food will stick more in those spots. plus, there runs the risk of more bits of that coating coming off into your food as you cook.

Non-stick pans and skillets are best for medium heat as they don’t conduct heat as well, and for wetter foods like eggs and fish and pancakes.

On the other hand, cast iron pans and skillets don’t have a built in protective coating. The metal will absorb grease and fats as they cook, building up an equally efficient non-stick coating of its own. And without the chemical coating that non-stick pans come with, there’s no risk of any of it flaking off or melting into your food. They can handle higher temperatures without damage, and they get hot faster on the burner. Beef, pork, and chicken are best cooked on cast iron.

You don’t want to let them soak in soap because it will remove that grease coating that makes the cast iron pan’s non-stickiness, plus absorb soap that might melt back off into your food. A soap and sponge rub down is all it needs.

@marraphy

PLEASE. LOUDER FOR THE PEOPLE IN THE BACK.

It drives me *nuts* whenever I see a roommate using a metal fork or utensil stirring their food in my NON-STICK FRYING PAN. Same goes for NON-STICK ELECTRIC SKILLET. *heathens*

Show a little care for your roommates belongings for Fucks Sake.

(via kunimitsuchin)

wemblingfool:

12b6:

biglawbear:

shoreslip:

biglawbear:

biglawbear:

steveheavy:

the-devils-dandy:

notsafef0rtwerk:

heyitscdubs:

biglawbear:

You know what, looking back on it, my friends and I survived the Bush Presidency

We would have survived a McCain Presidency

We would have survived a Romney Presidency

I honestly worry that there are some people who would not survive a Trump Presidency

I don’t care how much you love Gary Johnson, or Jill Stein. On November 8, 2016, one of two things will be true: either Hillary Clinton will be elected President, or Donald Trump will be elected President.

Which one, HONESTLY, would be worse?

This isn’t the year to “vote your conscience.”

There’s a fucking dangerous man one election away from being President.

This is the year to vote to survive.

Any other year, this would be an exaggeration. We survived Bush, we could have survived McCain or Romney. This year, Trump’s danger is no exaggeration.

Don’t vote your conscience, vote to survive.

We will not, not, NOT SURVIVE Trump.

The LGBT community will not survive.

The communities of middle eastern descent will not survive.

Women, especially women who want a right to choose, will not survive.

The black community will not survive.

The latino community will not survive.

The disabled community will not survive.

I guarantee that there are more groups.

We as a country will not survive a Trump-Pence Presidency

The poor will not survive

Please understand that Trump plans to not only do what the US did to Japanese Americans in WWII on a massive level with Mexicans and Muslims but also destroy the economy with it

Somehow this post is going around again and it’s appeared on my own dash and I still think Trump is going to kill us all. Y'all’s protest votes did nothing.

Hey look it’s my post from 2016

Now that it’s almost 2020, can you see that this wasn’t a fucking exaggeration

Do you understand now

This is going around again and now that we’re in the Democratic Primaries and y'all are already saying about how you’ll stay home if you’re favorite doesn’t win I’d just like to remind y'all that people are dying in the Trump administration

People are dying in concentration camps at the border

Trump rolled back Obamacare and now millions more people are without insurance

Trump is rolling back environmental regulations and climate change and pollution will kill us

States are banning abortion which will affect millions of poor women and women of color and SCOTUS night overturn Roe v Wade

Hate crimes against Jews and people of color and LGBT people are going up

There are Nazis in the White House and marching in the streets

And Trump has given tax cuts to billionaires and appointed judges that will take away your constitutional rights

Are you happy with your choice to vote third party? To stay home? Was it worth it? Was all of this worth it?

We’re facing the same choice again. We can’t have four more years of this.

Fight like hell for your candidate in the primaries. Then if and when they lose, get in line behind the winner.

We failed in 2016. The life and death stakes in 2020 are even higher.

Vote. For. Democrats.

The first sentiment in this post has gotten more literal as 2020 wears on.

I haven’t even updated this post to reflect the pandemic because I just

Tens of thousands of people are dead y'all. Obama and Biden had an entire infrastructure, a system to deal with pandemics and Trump abolished the office and ignored reports of the virus for months

When the curve of infections increases exponentially, even acting one day earlier could have saved thousands of lives

And Trump ignored it for months

Unemployment is now higher than at any time since the great depression

I knew people would die but I never imagined that Trump would be responsible for this many deaths and the worst economic disaster in a century

We have to vote for Biden. I don’t like Biden. I wanted someone progressive. Someone who didn’t sexually assault someone. But this is literally life and death.

(also Ruth Bader Ginsburg is 87 years old and has been hospitalized multiple times in the last year and we cannot allow Trump to appoint her replacement on the Supreme Court or continue giving lifetime appointments to judges to lower Federal courts)

This whole post y’all

So far over 130,000 people have not survived a Trump presidency. And that number is still skyrocketing.

(via reunicluster)

grittynityohsopretty:

Rounding in the wards. *sigh*

lmao 

The 1st year interns are now 2 weeks deep into the floors. Be nice to them. This is when the sleep deprivation kicks in on overdrive.